Provider Demographics
NPI:1720621204
Name:BRYANT, LEVINA K
Entity Type:Individual
Prefix:
First Name:LEVINA
Middle Name:K
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 PROFESSIONAL DR APT 707
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-5784
Mailing Address - Country:US
Mailing Address - Phone:817-209-8249
Mailing Address - Fax:
Practice Address - Street 1:5300 PROFESSIONAL DR APT 707
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-5784
Practice Address - Country:US
Practice Address - Phone:817-209-8249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver